Please click the following link for a PDF file of the Uterine Fibroids Report 2021

UTERINE FIBROIDS IN FLORIDA

2021 Narrative Summary of the Data

Introduction

According to the Mayo Clinic, uterine fibroids (also known as uterine leiomyomas) are noncancerous growths in the uterus that can develop during a woman's childbearing years. The cause of fibroids is not well understood. They are associated with infertility and can cause excessive menstrual bleeding, pelvic pain and other symptoms that affect a woman’s quality of life.[1] Risk factors for uterine fibroids include a family history of fibroids, obesity, early onset of puberty,[2] race, age, time since last birth, premenopausal states, hypertension, and diet.[3] Approximately, 20%–80% of women develop fibroids by age 50 years.[4] According to a nationally representative survey of inpatient hospitalizations for US women ages 15 to 54 years, the rate of fibroid-related hospitalization was 42 per 10,000 women-years.[5]

Risk Factors[6]

• Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids frequently shrink.

• Family history. Having a family member with fibroids increases the risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
• Race and Ethnic origin. Non-Hispanic Black women are more likely to develop fibroids than non-Hispanic White women.
• Obesity. Women who are overweight or obese are at a higher risk for fibroids. Overweight or obese women are two or three times more likely to get fibroids than normal weight women.
• Eating habits. Eating a lot of red meat and ham is linked with higher risk of fibroids. Eating plenty of green vegetables seem to protect women from developing fibroids.
• Vitamin D deficient/insufficiency. Vitamin D is a powerful inhibitor of fibroid growth but only 10 percent of Black women had adequate levels. Sunlight (in moderation), supplements and food sources (i.e. salmon) can help improve Vitamin D levels.

Methodology

Florida Pregnancy-Associated Mortality Review (PAMR) data for 2014-2019 and Florida Agency for Health Care Administration Hospital Discharge data for 2016-2019[7] were used to prepare this brief. The hospital discharge data is restricted to women between 15 and 54 years of age.

Results

Hospital Discharge Data

According to 2016–2019 hospital discharge data, 43.8 per 10,000 women in Florida ages 15-54 years had a fibroid diagnosis.[8] In Florida from 2016–2019, the rate of fibroid cases per 10,000 women did not significantly change from 2016 (45.9) to 2019 (44.3) (Figure 1).

From 2016–2019, most women with fibroids in Florida were 35–49 years of age (63.7%) (Figure 2).

Among women ages 15–54 years with fibroids in Florida from 2016–2019, fibroids were most prevalent for non-Hispanic Black women (46.1%), followed by non-Hispanic White women (25.4%), Hispanic women (23.9%), and then non-Hispanic women of other races (4.5%) (Figure 3). 

Pregnancy Associated Mortality Review Data

Florida’s PAMR is a continuous system of surveillance that collects and analyzes information related to maternal deaths.  This analysis is used to develop guidelines for prevention and interventions through evidence-based actions intended to lower pregnancy-related deaths (PRDs) that can occur during pregnancy, labor, delivery, or the postpartum period.

Figure 4. Fibroid Case Count in Pregnancy-Related Deaths, Florida 2014–2019

 From 2014 to 2019, there were 216 women who died of PRD causes. Of them, 5% (10 women) had a history of fibroids. Of the women who died and had a history of fibroids, the causes of death were hemorrhage (n=2), thrombotic embolism (n=2), cardiomyopathy (n=2), infection (n=2), hypertension (n=1) and unknown (n=1) (Figure 4).

Among women with a PRD and a history of fibroids, 90% were older than 30 years, 60% had a cesarean delivery, 60% were not discharged from the hospital, 50% were obese (BMI >= 30), and 50% were non-Hispanic Black women.

Limitations

Due to asymptomatic cases of fibroids, it is hard to estimate their prevalence.[9] Therefore, the data on hospitalizations likely underestimate how widespread fibroids are among women in Florida as it only captures more severe cases.

Conclusions

Uterine fibroids are commonly experienced by women of reproductive age. The prevalence of uterine fibroids in Florida is comparable to the nation and varies by age and race/ethnicity. Furthermore, uterine fibroids are rare among women who died of a pregnancy-related cause in Florida.

[1]Uterine Fibroid - an overview | ScienceDirect Topics

[2]https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288

[3] Stewart, E. A., Cookson, C. L., Gandolfo, R. A., & Schulze‐Rath, R. (2017). Epidemiology of uterine fibroids: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 124(10), 1501-1512. Vollenhoven, B. J., Lawrence, A. S., & Healy, D. L. (1990). Uterine fibroids: a clinical review. BJOG: An International Journal of Obstetrics & Gynaecology, 97(4), 285-298.

[4]https://www.womenshealth.gov/a-z-topics/uterine-fibroids

[5]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746963/

[6]https://www.thewhitedressproject.org/overview-1; https://medlineplus.gov/uterinefibroids.html#summary

[7]  Data prior to 2016 were not included because of the change from ICD-9 to ICD-10 disease classification systems in October of 2015. This change restricts the examination of trends as the data are incomparable. Likewise, recently published fibroids reports based on national data relied on ICD-9 data pre-2016 and therefore cannot be compared to the Florida ICD-10 data presented here.

[8] International Classification of Diseases, Tenth Revision (ICD-10) codes D25.0, D25.1, D25.2, D25.9 or Diagnosis-Related Group (DRG) codes 760 and 761.

[9] Marsh, E. E., Al-Hendy, A., Kappus, D., Galitsky, A., Stewart, E. A., & Kerolous, M. (2018). Burden, prevalence, and treatment of uterine fibroids: a survey of US women. Journal of Women's Health, 27(11), 1359-1367.